Provider Demographics
NPI:1215963087
Name:SEGRAVES, ROBERT TAYLOR (MD, PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TAYLOR
Last Name:SEGRAVES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23230 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5446
Mailing Address - Country:US
Mailing Address - Phone:216-831-2900
Mailing Address - Fax:
Practice Address - Street 1:23230 CHAGRIN BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5446
Practice Address - Country:US
Practice Address - Phone:216-831-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350539472084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0681472Medicaid
OHSE7269341Medicare ID - Type Unspecified
OH0681472Medicaid